Friday
Apr292016

Getting on the Blockchain Bandwagon

By Kim Bellard, April 28, 2016

Face it: health care IT infrastructure is a mess.  After spending tens of billions of dollars to "incent" providers to move to EHRs, they're using them but are not very happy with them. We now have millions of electronic records that are still way too siloed, and all too often incomplete.

Enter blockchain.

To the extent most people think of blockchain at all, it is in relation to one of its most prominent users, Bitcoin.  Bitcoin, which has its passionate advocates and equally passionate skeptics, is not synonymous with blockchain.  Blockchain is the technology that allows Bitcoin to operate, but they are no more one and the same than Salesforce.com and Oracle are.

In layman's terms -- and, trust me, when it comes to this I definitely am a layman -- blockchain is a set of distributed records, or databases, that are shared by multiple parties and which can only be updated by a majority of those parties.  There is no central authority, no central database.  It reminds me of the Internet's distributed networks, which help assure its robustness. 

Equally important, in blockchain once a record is stored (or "transcribed"), it can't be tampered with.  For better or for worse, Bitcoin has demonstrated that blockchain does, in fact, assure anonymity, privacy and security. 

Blockchain is starting to become more visible even outside of Bitcoin.  Businesses are being told they need a "blockchain czar.  Wall Street is starting to embrace it.  Britain looking into using it for manage the distribution of public money
 
Some people think it is the greatest thing since sliced bread -- or, in modern terms, since the Internet.  IBM's Jerry Cuomo says: "Blockchain has the potential to become the technological foundation for all electronic transactions conducted over the Internet."

If they are even remotely right, blockchain is something that we better be paying attention to, and what industry needs its advantages more than health care?

We're already beginning to see blockchain show up more in health care.  For example, Gem just announced Gem Health, As they say: "We need a modern infrastructure that unlocks new channels for services to connect, while balancing the need for strong data privacy and security.  Blockchain technology is that infrastructure."

Philips is onboard, with the Philips Blockchain Lab joining the Gem Health network.

It's not going to be easy.  Health care has had a hard time agreeing to things like ICD-10 or HL7, much less interoperability standards.  In CIO, Peter B. Nichol points out the need for foundational protocols, such as the Linux Foundation's Hyperledger project is working on  If we thought getting providers to use EHRs was hard, picture trying to get the health care industry onto a entirely new technology platform like blockchain. 

True to form, the "HIT standards mandarins" are already showing resistance to blockchain.

However, Mr. Nichol also enumerates a number of companies already jumping on the blockchain bandwagon for healthcare uses, including not just Gem but also TierionFactomHealthNautica, and Guardtime.  It is something that any organization involved in health care can ignore only at their own risk.

Look, I'm no technology seer.  I don't know if blockchain is going to totally revamp how we store and update data, as its proponents claim.  What I do know is that, when it comes to health care, our current approaches are not getting us to the interoperability that we need, or are doing so only at glacial speeds, and that they allow our electronic data to be increasingly vulnerable.   

If not blockchain, what?

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

Wednesday
Apr202016

Cyber attacks – a new reality for health care organizations

By Claire Thayer, April 20, 2016

The healthcare industry as a whole is at a critical juncture in its efforts to curb medical identity theft, data breaches and health care fraud. More than any other industry, health care is now leading the way for the highest number of records breached - 84.4 million alone in the first half of 2015. Hospitals, health plans, health systems and provider organizations are all doubling down on efforts to address vulnerabilities related to cyber attacks. And, the sooner the better – as consumers are starting to take notice - about 50% say they wouldn’t hesitate to find another healthcare provider if they were concerned about the security of their medical records.

Cyber threats now have the full attention of the c-suite. A recent HIMSS Cybersecurity Survey finds:

  • 87% of healthcare leaders indicated that information security had become a critical business priority
  • 66% of healthcare organizations experienced a significant security incident
  • 57% of healthcare organizations have allocated a full-time resource to address cybersecurity
  • 81% of respondents believe more innovative and advanced tools are needed to combat security threats

These and issues pertaining to identity management in health care are the focus of a recent MCOL infographoid, co-sponsored by LexisNexis Healthcare, highlighted below:

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

Monday
Apr182016

Health Systems Advised to Tread Carefully When Considering Provider-led Health Plans 

By Claire Thayer, April 18, 2016

McKinsey & Co released an in-depth paper that explores both growth and evolution of provider-led health plans and offers key questions health systems should think about when evaluating their current plans or considering offering stepping into to provider-led plan market space. Here are some of the highlights gleaned from this paper.

The authors point out that overall, the growth in enrollment of provider led plans has increased 6% since 2010, growing from 12.4 million in enrollment to 15.3 million in 2014. While during this same time period, growth in the number of provider-led health plans was modest, increasing just 3% from 94 plans in 2010 to 106 in 2014. The enrollment growth was most pronounced in the Medicaid, Medicare Advantage and Individual Markets

The authors point to 4 important questions that are critical for health systems to consider when evaluating provider-led health plan (PLHP) offerings:

  • How can consumerism benefit a PLHP
  • When is growth through a PLHP most likely
  • Is an alternative type of administrative infrastructure possible?
  • What can be gained through granular analytics?

For further reading:

Article Summary: The market evolution of provider-led health plans [McKinsey & Company]

Full Article: The market evolution of provider-led health plans [McKinsey & Company]

Friday
Apr152016

Ten Things to Know About The Comprehensive Primary Care Plus (CPC+) model

By Clive Riddle, April 15, 2016

1.  CPC+ is a CMS five-year initiative starting in January 2017 to create a national advanced primary care medical home model that aims to strengthen primary care through a regionally-based multi-payer payment reform and care delivery transformation.

2. CPC+ will be implemented in up to 20 regions and can accommodate up to 5,000 practices, which would encompass more than 20,000 doctors and clinicians and the 25 million people they serve.

3. The multi-payer approach involves Medicare partnering with commercial and state health insurance plans to support primary care practices in delivering advanced primary care.

4. Advanced primary care has five key components:

  • Services are accessible, responsive to an individual’s preference, and patients can take advantage of enhanced in-person hours and 24/7 telephone or electronic access;
  • Patients at highest risk receive proactive, relationship-based care management services to improve outcomes;
  • Care is comprehensive and practices can meet the majority of each individual’s physical and mental health care needs, including prevention. Care is also coordinated across the health care system, including specialty care and community services, and patients receive timely follow-up after emergency room or hospital visits:
  • It is patient-centered, recognizing that patients and family members are core members of the care team, and actively engages patients to design care that best meets their needs:
  • Quality and utilization of services are measured, and data is analyzed to identify opportunities for improvements in care and to develop new capabilities.

5. CPC+ lists five patient care objectives to help primary care practices:

  • Support patients with serious or chronic diseases to achieve their health goals;
  • Give patients 24-hour access to care and health information;
  • Deliver preventive care;
  • Engage patients and their families in their own care; and
  • Work together with hospitals and other clinicians, including specialists, to provide better coordinated care

6. CPC+ will include two primary care practice tracks with incrementally advanced care delivery requirements and payment options. Practices in both tracks will receive up-front incentive payments that they will either keep or repay based on their performance on quality and utilization metrics. Practices in both tracks also will receive data on cost and utilization.

7. Track 1 practices will receive a monthly care management fee in addition to the fee-for-service payments under the Medicare Physician Fee Schedule for activities.

8. Track 2 practices will be expected to provide more comprehensive services for patients with complex medical and behavioral health needs. Track 2, practices will also receive a monthly care management fee and, instead of full Medicare fee-for-service payments for Evaluation and Management services, will receive a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments for those services. Track 2 practices’ vendors will sign a Memorandum of Understanding (MOU) with CMS that outlines their commitment to supporting practices’ enhancement of health IT capabilities.

9. CPC+ was developed through the ACA enacted Center for Medicare and Medicaid Innovation, and is an outgrowth of the Comprehensive Primary Care (CPC) initiative, a model tested through the Center for Medicare & Medicaid Innovation that began October 2012 and runs through December 31, 2016

10. CMS will accept payer proposals to partner in CPC+ from April 15 through June 1, 2016. CMS will accept practice applications in the determined regions from July 15 through September 1, 2016. CMS will select regions for CPC+ where there is sufficient interest from multiple payers to support practices’ participation in the initiative.

Here’s where you can find out more:

Tuesday
Apr122016

52% of healthcare IT leaders evaluating cloud-based solutions for population health management

By Claire Thayer, April 12, 2016

A recent HIMSS Media survey of healthcare IT leaders identifies five key challenges in using connected health IT applications to support population health management:

  • Care Coordination – 23.5%
  • Financial investment in IT – 21.4%
  • Data Management – 18.4%
  • Patient Engagement & Adherence – 14.3%
  • Cohort identification and risk stratification – 12.2%

With the growing consumer interest in all things mobile, it’s not a surprise to see that many of these health IT leaders are giving serious considerations to population health platforms that support telehealth systems with back-end integration services.  Notably, 52% are evaluating cloud-based solutions and more than half say they intend to adopt mobile wellness monitoring apps for their population health management needs.